What Causes Early Satiety and Fullness?

Early satiety is feeling too full to finish a meal although you have eaten far less than you would normally be able to eat.

Postprandial fullness, on the other hand, is the stomach feeling excessively full, heavy or tight for a long time after the meal has finished.

Fullness after an occasional large meal can be normal. Feeling full continually on a small amount of food, or an uncomfortable fullness that persists for a long time after eating, is nevertheless a complaint that needs to be investigated.

Are early satiety and loss of appetite the same thing?

No.

In loss of appetite, the person’s desire to eat is reduced.

A person with early satiety, by contrast, may want to eat and may be hungry, but after a few mouthfuls feels the stomach is full and cannot finish the meal.

This distinction is important when investigating the cause of the complaint.

What causes early satiety?

The stomach is not simply an organ that stores what we eat.

During a meal, the upper part of the stomach relaxes to make room for the food. The contractions of the stomach then grind the food and send it on to the duodenum in a controlled way.

A disturbance in any of these processes can cause early satiety and fullness after meals.

Functional dyspepsia

One of the common causes of early satiety and uncomfortable fullness after meals is functional dyspepsia.

Patients may have:

• Early satiety
• Excessive fullness after meals
• Pain over the stomach
• Burning over the stomach
• Bloating
• Nausea

Investigations may show no structural disease such as an ulcer or a tumour to explain the symptoms.

This does not mean that the patient’s symptoms are not real. Changes in how the stomach accommodates food, in its movement, and in the sensitivity of the stomach and duodenum can play a part in the symptoms.

Does gastroparesis cause early satiety?

Yes.

In gastroparesis the emptying of the stomach is delayed although there is no mechanical obstruction at its outlet.

This can result in:

• Early satiety
• Prolonged fullness after meals
• Nausea
• Vomiting
• Bloating
• Discomfort in the upper abdomen

Diabetes is one of the important causes of gastroparesis. Certain operations, medicines and other diseases can also affect the emptying of the stomach.

Can the medicines being taken have an effect?

Yes.

Certain medicines can slow the emptying of the stomach, or contribute to a feeling of early satiety through their effects on appetite and the digestive system.

The GLP-1 receptor agonists used in recent years for weight loss or in the treatment of diabetes in particular can slow gastric emptying and produce marked fullness, nausea or early satiety.

Opioid painkillers and certain other medicines can also affect the movement of the stomach and bowel.

Where symptoms are newly started, it is important to review the medicines being taken.

Medicines taken regularly should not be stopped without a doctor’s advice.

Can there be an obstruction at the outlet of the stomach?

More rarely, a narrowing or obstruction at the outlet of the stomach can prevent food from passing through.

Narrowings due to previous ulcers, and certain tumours, can cause this.

Where early satiety is accompanied by recurrent vomiting and weight loss in particular, assessment should not be delayed.

Is early satiety a sign of cancer?

Early satiety does not by itself mean cancer, and in most patients other causes are found.

Early satiety can nevertheless be seen in certain diseases of the stomach and neighbouring organs.

Where there is:

• Newly started and steadily increasing early satiety
• Unexplained weight loss
• Anaemia
• Persistent vomiting
• Difficulty swallowing
• Signs of bleeding in the digestive system

in particular, it is important to exclude organic disease.

Are bloating and early satiety the same thing?

No, although they can occur together.

Bloating is more a feeling of fullness, tightness or distension in the abdomen.

Early satiety is the appearance of a feeling of fullness before the meal can be finished.

This distinction can help the doctor to decide which diseases to investigate.

Can early satiety cause weight loss?

Yes.

If the patient can only eat small amounts continually, the daily intake of calories and nutrients can fall.

Where this goes on for a long time, weight loss and certain nutritional deficiencies can develop.

For this reason, early satiety accompanied by marked weight loss should not simply be regarded as “a sensitive stomach”.

What can help early satiety and fullness?

Treatment is carried out according to the underlying cause.

In some patients the following may help:

• Eating smaller portions rather than large meals
• Eating slowly
• Cutting down very fatty and heavy meals
• Not lying down immediately after eating
• Identifying the foods that markedly increase the symptoms

In patients with gastroparesis, dietary advice may be rather different and should be planned individually.

Following unnecessary and excessively restrictive diets for a long time is not right.

When should a doctor be consulted?

Early satiety should be assessed if it:

• Has become continual
• Is steadily increasing
• Is preventing adequate nutrition
• Is causing unexplained weight loss
• Is accompanied by persistent nausea or vomiting
• Occurs together with abdominal pain
• Occurs where anaemia has been found
• Occurs together with difficulty swallowing
• Occurs together with vomiting blood or black stools

How is early satiety investigated?

The doctor first assesses how long the complaint has lasted, its relationship to meals, any change in weight, the medicines being taken and the accompanying symptoms.

Depending on the patient’s circumstances, investigations such as:

• Blood tests
• Gastroscopy
• Ultrasound
• Computed tomography
• Gastric emptying studies

may be required.

In patients in whom gastroparesis is suspected, the emptying of the stomach may need to be assessed objectively.

Not every patient with early satiety needs all of these tests.

Remember

Early satiety and loss of appetite are not the same thing.

If a person wants to eat and yet feels full after a few mouthfuls, this is regarded as early satiety.

Functional dyspepsia and disorders of gastric emptying are among the common causes. Where early satiety is newly started in particular, and occurs together with weight loss, anaemia, persistent vomiting or signs of bleeding, it is important to investigate the cause.